The majority of research on the moral development of nurses is in line with Kohlberg’s theory. However, Gilligan noted that care and justice perspectives coexist in moral conflict, and during the growth process, each...The majority of research on the moral development of nurses is in line with Kohlberg’s theory. However, Gilligan noted that care and justice perspectives coexist in moral conflict, and during the growth process, each complements each other and promotes moral development and maturation. Chally, referring to Gilligan’s theory, which has the perspective of relationship-focused care, argued that the moral development of nurses should be considered from both care and justice perspectives. In this paper, we analyzed publications that used Gilligan protocol to conduct research on moral conflicts experienced by nurses. Given the importance of care and justice perspectives in moral reasoning, Gilligan’s theory, which incorporates both perspectives, is useful for analyzing moral reasoning in nurses. Our analysis suggests that attachment and connections based on relationships with patients and self-care are essential elements of care, and self-care is important in moral decision making. The inequality between nurse and physician roles was an issue raised with the justice perspective. Since nurses’ roles are strongly influenced by their affection toward and connections with their patients, it is important not to overemphasize either perspective.展开更多
Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to mak...Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to make a functional recovery because of multiple organ dysfunction syndromes.Under such a circumstance,withdrawal of treatment will inevitably be considered,although his family refused to do so.Consequently,acritical question must be answered:Who should make the decision?Ethical dilemma identification:Danny decided to withdraw the use of life-support,whilst his wife and adult children refused to do so.The ethical dilemma is illustrated by the following question:Who decides the withdrawal of treatment in a critical care setting?Analysis:To provide an opotional solution to this case and make the best moral decision,the current study will critically discuss this issue in conjunction with ethical principles,philosophical theories and the values statement of the European and Chinese nurses'codes of ethics.Additionally,the associated literature relative to this case are analysed before the decision-making.Ethical decision-making:The best ethical decision is Danny can decide whether to withhold or withdraw life-sustaining treatment.If his family is involved in the discussion,the medical staff should balance the ethical principles when they make the decision and allocate reasonable resources for patients.Results:In Danny's case,health professionals opted to respect his decision to withdraw treatment.The medical staff maintained an effective communication with the family involved,and provided the appropriate intervention to collaborate with other health care professionals to perfect further care.展开更多
Background: As medical technology has advanced, it has also made it possible to maintain end-stage life support for longer periods of time, but it has also been accompanied by a debate about ineffective care, nursing ...Background: As medical technology has advanced, it has also made it possible to maintain end-stage life support for longer periods of time, but it has also been accompanied by a debate about ineffective care, nursing is considered to be an ethically important profession, and nurses aim to achieve ethical goals such as providing the best possible care to patients, achieving high quality outcomes, but it is common when there are insufficient numbers of staff, inadequately trained staff, and organizational policies and procedures that make it difficult, or even impossible, for nurses to meet the needs of patients and their families. This conflict results in moral distress for nurses, yet limited attention has been paid to this phenomenon. Objective: To explore the current phenomenon of moral distress and its triggering factors in nurses in tertiary grade A hospitals in Wuhan, by targeting root causes and understanding the interplay between nurses and settings where moral distress occurs, interventions can be tailored to minimize moral distress with the ultimate goal of enhancing patient care. Method: Totally 384 nurses from clinical departments in 2 tertiary Grade A hospitals in Wuhan were investigated with the Chinese version Moral Distress Scale-Revised (MDS-R). Result: The total score of moral distress was 47.41 ± 27.14, and the mean scores of moral distress frequency and intensity were 1.01 ± 0.53 and 1.19 ± 0.61, which were at a lower level. The main source of moral distress for nurses is related to end-of-life care and medical decision communication;Nurses’ moral distress scores were statistically significant (P Conclusion: Hospital facility leaders and nursing managers need to train nurses to develop competency development such as reflection, empathy, communication, positive thinking, and emotional intelligence to practice ethical dilemma response, and facilitate collaborative communication among healthcare members, so as to alleviate moral distress in nurses.展开更多
目的系统评价安宁疗护护士道德困境体验。方法计算机检索PubMed、Web of Science、CINAHL、Embace、Cochrane Library、Scopus、中国知网、中国生物医学文献数据库、维普数据库及万方等数据库,收集与安宁疗护护士道德困境体验相关的质...目的系统评价安宁疗护护士道德困境体验。方法计算机检索PubMed、Web of Science、CINAHL、Embace、Cochrane Library、Scopus、中国知网、中国生物医学文献数据库、维普数据库及万方等数据库,收集与安宁疗护护士道德困境体验相关的质性研究,检索时限为建库至2024年3月。运用澳大利亚JBI循证卫生保健中心质性研究质量评价标准对纳入文献的质量进行评价。采用汇集性整合方法进行结果整合和归纳。结果共纳入11篇文献,提炼出38个研究结果,归纳为9个类别,得到3个整合结果:安宁疗护实践中的道德挑战;道德困境触发负性情绪;调整与应对。结论安宁疗护护士具有复杂的道德困境,需要护理管理者重视其困境体验并提供多样化支持,以改善安宁疗护护士工作中的道德困境。展开更多
目的了解重症监护室护士道德困境的真实体验,为管理者制定干预措施,提高重症监护室护士幸福感,稳定护理队伍提供参考。方法检索中国知网、维普、中国生物医学文献数据库、万方、PubMed、the Cochrane Library、Web of Science、Embase...目的了解重症监护室护士道德困境的真实体验,为管理者制定干预措施,提高重症监护室护士幸福感,稳定护理队伍提供参考。方法检索中国知网、维普、中国生物医学文献数据库、万方、PubMed、the Cochrane Library、Web of Science、Embase数据库关于重症监护室护士道德困境的质性研究,检索时限为建库至2023年7月24日。根据JBI循证卫生保健中心推荐的质性研究质量评价标准对纳入文献进行质量评价,运用Meta整合方法对研究结果进行整合。结果共纳入8篇文献,从纳入研究中提炼出36个主题,将其归纳成为10个新类别,综合成3个整合结果,即ICU护士经历道德困境受多种因素影响,护士遭遇道德困境时的情感体验,应对道德困境的策略。结论重症监护室护士存在一定程度的道德困境,护理管理者应了解其产生的原因,并制定和实施有效干预措施,以减少重症监护室护士道德困扰,促进护士生理心理健康发展,稳定护理队伍。展开更多
文摘The majority of research on the moral development of nurses is in line with Kohlberg’s theory. However, Gilligan noted that care and justice perspectives coexist in moral conflict, and during the growth process, each complements each other and promotes moral development and maturation. Chally, referring to Gilligan’s theory, which has the perspective of relationship-focused care, argued that the moral development of nurses should be considered from both care and justice perspectives. In this paper, we analyzed publications that used Gilligan protocol to conduct research on moral conflicts experienced by nurses. Given the importance of care and justice perspectives in moral reasoning, Gilligan’s theory, which incorporates both perspectives, is useful for analyzing moral reasoning in nurses. Our analysis suggests that attachment and connections based on relationships with patients and self-care are essential elements of care, and self-care is important in moral decision making. The inequality between nurse and physician roles was an issue raised with the justice perspective. Since nurses’ roles are strongly influenced by their affection toward and connections with their patients, it is important not to overemphasize either perspective.
文摘Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to make a functional recovery because of multiple organ dysfunction syndromes.Under such a circumstance,withdrawal of treatment will inevitably be considered,although his family refused to do so.Consequently,acritical question must be answered:Who should make the decision?Ethical dilemma identification:Danny decided to withdraw the use of life-support,whilst his wife and adult children refused to do so.The ethical dilemma is illustrated by the following question:Who decides the withdrawal of treatment in a critical care setting?Analysis:To provide an opotional solution to this case and make the best moral decision,the current study will critically discuss this issue in conjunction with ethical principles,philosophical theories and the values statement of the European and Chinese nurses'codes of ethics.Additionally,the associated literature relative to this case are analysed before the decision-making.Ethical decision-making:The best ethical decision is Danny can decide whether to withhold or withdraw life-sustaining treatment.If his family is involved in the discussion,the medical staff should balance the ethical principles when they make the decision and allocate reasonable resources for patients.Results:In Danny's case,health professionals opted to respect his decision to withdraw treatment.The medical staff maintained an effective communication with the family involved,and provided the appropriate intervention to collaborate with other health care professionals to perfect further care.
文摘Background: As medical technology has advanced, it has also made it possible to maintain end-stage life support for longer periods of time, but it has also been accompanied by a debate about ineffective care, nursing is considered to be an ethically important profession, and nurses aim to achieve ethical goals such as providing the best possible care to patients, achieving high quality outcomes, but it is common when there are insufficient numbers of staff, inadequately trained staff, and organizational policies and procedures that make it difficult, or even impossible, for nurses to meet the needs of patients and their families. This conflict results in moral distress for nurses, yet limited attention has been paid to this phenomenon. Objective: To explore the current phenomenon of moral distress and its triggering factors in nurses in tertiary grade A hospitals in Wuhan, by targeting root causes and understanding the interplay between nurses and settings where moral distress occurs, interventions can be tailored to minimize moral distress with the ultimate goal of enhancing patient care. Method: Totally 384 nurses from clinical departments in 2 tertiary Grade A hospitals in Wuhan were investigated with the Chinese version Moral Distress Scale-Revised (MDS-R). Result: The total score of moral distress was 47.41 ± 27.14, and the mean scores of moral distress frequency and intensity were 1.01 ± 0.53 and 1.19 ± 0.61, which were at a lower level. The main source of moral distress for nurses is related to end-of-life care and medical decision communication;Nurses’ moral distress scores were statistically significant (P Conclusion: Hospital facility leaders and nursing managers need to train nurses to develop competency development such as reflection, empathy, communication, positive thinking, and emotional intelligence to practice ethical dilemma response, and facilitate collaborative communication among healthcare members, so as to alleviate moral distress in nurses.
文摘目的系统评价安宁疗护护士道德困境体验。方法计算机检索PubMed、Web of Science、CINAHL、Embace、Cochrane Library、Scopus、中国知网、中国生物医学文献数据库、维普数据库及万方等数据库,收集与安宁疗护护士道德困境体验相关的质性研究,检索时限为建库至2024年3月。运用澳大利亚JBI循证卫生保健中心质性研究质量评价标准对纳入文献的质量进行评价。采用汇集性整合方法进行结果整合和归纳。结果共纳入11篇文献,提炼出38个研究结果,归纳为9个类别,得到3个整合结果:安宁疗护实践中的道德挑战;道德困境触发负性情绪;调整与应对。结论安宁疗护护士具有复杂的道德困境,需要护理管理者重视其困境体验并提供多样化支持,以改善安宁疗护护士工作中的道德困境。
文摘目的了解重症监护室护士道德困境的真实体验,为管理者制定干预措施,提高重症监护室护士幸福感,稳定护理队伍提供参考。方法检索中国知网、维普、中国生物医学文献数据库、万方、PubMed、the Cochrane Library、Web of Science、Embase数据库关于重症监护室护士道德困境的质性研究,检索时限为建库至2023年7月24日。根据JBI循证卫生保健中心推荐的质性研究质量评价标准对纳入文献进行质量评价,运用Meta整合方法对研究结果进行整合。结果共纳入8篇文献,从纳入研究中提炼出36个主题,将其归纳成为10个新类别,综合成3个整合结果,即ICU护士经历道德困境受多种因素影响,护士遭遇道德困境时的情感体验,应对道德困境的策略。结论重症监护室护士存在一定程度的道德困境,护理管理者应了解其产生的原因,并制定和实施有效干预措施,以减少重症监护室护士道德困扰,促进护士生理心理健康发展,稳定护理队伍。
